NPIMap

Organization Active NPI

Greater Baden Medical Service Incorporated

  • Federally Qualified Health Center (FQHC)
  • Lexington Park, MD
National Provider Identifier
1851010771
Registry record updated Mar 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GREATER BADEN MEDICAL SERVICE INCORPORATED
Practice address
21625 Great Mills Rd
Lexington Park, MD 20653-1239
Phone
(301) 637-8331
Fax
(301) 637-6625
NPI assigned
Aug 24, 2022
Last updated
Mar 13, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
GREATER BADEN MEDICAL SERVICE INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeffrey A Kurcab
Title
Cfo
Phone
(301) 599-2172

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Health Educator 174H00000X NU

Addresses

Primary practice location

21625 Great Mills Rd
Lexington Park, MD 20653-1239

Mailing address

7450 Albert Rd FL 3
Brandywine, MD 20613-3035
Phone (301) 888-3322

Other identifiers 1

IdentifierTypeStateIssuer
911431900MedicaidMD

Other names 1

  • Greater Baden Medical Service at Pax River Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230315002579 MD Part A Provider - Federally Qualified Health Center (FQHC) 4981632650 Practice locations: Lexington Park, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851010771. Details of each certification follow.

Federally qualified health center certification: CCN 211035

Legal name
GREATER BADEN MEDICAL SERVICE INCORPORATED
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 27, 2023
Last certification
Feb 27, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 14, 1972 in MD
Enrollment address
21625 Great Mills Rd
Lexington Park, MD 20653-1239

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Greater Baden Medical Service Inc15 organizations share this tax ID, including this one
Part of
Greater Baden Medical Service Inc

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

21625 Great Mills Rd
Lexington Park, MD 20653
Phone (301) 637-8331

21625 Great Mills Rd
Fl 1
Lexington Park, MD 20653
Phone (301) 637-8331

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Roxann Cooper Individual Corporate OfficerBoard Member May 1, 2021
Joan F Hepburn Individual Corporate OfficerBoard Member May 1, 2011
Dale E Speake Individual Corporate OfficerBoard Member Feb 1, 1990
Jeffrey a Kurcab Individual Corporate OfficerCfo Jan 17, 2022 100%
W-2 Managing EmployeeCfo Jan 17, 2022 100%
Brandon Jones Individual Corporate OfficerChair Feb 1, 2017
Christopher Demarco Individual Corporate OfficerCeo Jan 1, 2023
Robert Harold Eaton Individual Corporate OfficerTreasurer Oct 1, 2018
Mary Ann Friis Individual Corporate OfficerVice Chair Oct 1, 2010

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741824000000",
    "number": "1851010771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7450 ALBERT RD FL 3",
            "city": "BRANDYWINE",
            "state": "MD",
            "postal_code": "206133035",
            "telephone_number": "301-888-3322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21625 GREAT MILLS RD",
            "city": "LEXINGTON PARK",
            "state": "MD",
            "postal_code": "206531239",
            "telephone_number": "301-637-8331",
            "fax_number": "301-637-6625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER BADEN MEDICAL SERVICE INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREATER BADEN MEDICAL SERVICE INCORPORATED",
        "enumeration_date": "2022-08-24",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A",
        "authorized_official_last_name": "KURCAB",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "301-599-2172"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "911431900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greater Baden Medical Service at Pax River",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lexington Park, MD

Sources for this page

Verify at the official NPI Registry.